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The use of hydroxychloroquine (HCQ) in Primary Sjögren's Syndrome (pSS) has been assessed in different studies over the last years, with conflicting results regarding its efficacy in sicca syndrome and extraglandular manifestations (EGM). The goal of this study was to compare the incidence rate of EGM in pSS patients with and without HCQ therapy.We performed a multicenter retrospective study, including patients with pSS (European classification criteria) with at least 1 year of follow-up. Subjects with concomitant fibromyalgia, autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis were excluded. Demographics and pSS characteristics were recorded. The EGM were defined by EULAR-SS disease activity index (ESSDAI). Patients were divided into two groups according to their use or not of HCQ therapy. We evaluated the use of HCQ and its relationship to EGM. HCQ therapy was defined as the continuous use of the drug for at least 3 months. A descriptive analysis of demographics and pSS characteristics was performed. We compared the incidence of EGM between groups defined by HCQ therapy using chi2 test or Fisher's exact test. A total of 221 patients were included (97.3% women), mean age, 55.7 years (SD 14). Mean age at diagnosis, 48.8 years (SD 15); median disease duration, 60 months (IQR 35-84). One hundred and seventy patients (77%) received HCQ. About half of the patients had at least one EGM during the course of the disease, 20% of them developed an EGM before the onset of the sicca syndrome and 26% simultaneously with dryness symptom. Overall, EGM were less frequent in those on HCQ therapy (36.5% vs 63.5%, p < 0.001). Considering each EGM individually, the following manifestations were more frequent in the non-treated group: arthritis (p < 0.001), fatigue (p < 0.001), purpura (p = 0.01), Raynaud phenomenon (p = 0.003), and hypergammaglobulinemia (p = 0.006). Immunosuppressive treatment was indicated on 28 patients (12.7%), 13 of which were receiving also HCQ. The first reason for those treatments was the presence of arthritis in 12/28 patients (42.8%), and the drug used in all the cases was methotrexate. Only three patients required immunosuppressive therapy with cyclophosphamide, due to the presence of glomerulonephritis, vasculitis, and interstitial lung disease. None of the patients received biologic therapy. The lower incidence of EGM was observed in patients on HCQ therapy supports its efficacy in pSS. However, further large scale prospective studies are needed to confirm these findings.

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INTRODUCCIÓN: Los pacientes con artritis reumatoidea (AR) presentan una mobimortalidad cardiovascular (CV) 50-60% más alta comparada con la población general. En este grupo poblacional, la carga inflamatoria acumulada, medida por los niveles de VSG y PCR durante un período prolongado, se ha asociado con aterosclerosis subclínica, riesgo cardiovascular y mortalidad. En contrapartida, la presencia de un estado pro-inflamatorio conduciría a una disminución del colesterol total (CT), colesterol HDL y colesterol LDL, por lo que la contribución de los lípidos como factor de riesgo CV es, ciertamente, contradictorio. OBJETIVO Correlacionar los reactantes de fase aguda (VSG-PCR) y los valores de lípidos (CT, HDL, LDL) en una muestra de pacientes con AR. PACIENTES Y METODO: Estudio observacional, retrospectivo, analítico, en el que se incluyeron pacientes con diagnóstico de AR según criterios ACR/EULAR 2010. La relación entre los valores de CT, HDL, LDL con la PCR y VSG se analizó con correlación de Pearson. Dada la distribución no simétrica de los valores de PCR, se obtuvo una transformación logarítmica (logaritmo normal) de la misma. En un segundo modelo, los valores de CT, HDL y LDL se correlacionaron con el logaritmo normal de la PCR realizando distintos cortes de la misma (concentración de PCR ≤5 mg/l, > 5 a 10 mg/l). Finalmente, las correlaciones significativas, se incluyeron en un modelo de regresión lineal multivariado ajustado por edad, género, tiempo de evolución de la enfermedad, uso de hipolipemiantes, medicamentos biológicos y dosis de glucocorticoides. RESULTADOS El análisis de este estudio incluyó 449 mediciones del perfil de lípidos y reactantes de fase aguda (PCR y VSG) correspondientes a 318 pacientes. Los pacientes fueron predominantemente mujeres (79.5%), con una edad media (desviación estándar) de 57.7 (12.3) años. La mediana (rango intercuartilo) del tiempo de evolución de la enfermedad fue de 74.0 (108.0) meses. La mayoría de los pacientes eran seropositivos (67%). La correlación entre PCR y CT (r= 0.16; p= 0.60), así como sus fracciones HDL (0.09; p= 0.30) y LDL (r= 0.09; p= 0.36), fueron débiles. En el sub-análisis de la PCR dividida en tres valores de corte, tanto el CT (r= -0.18 a 0.09) y la fracción LDL (r= -0.34 a 0.11) mostraron correlaciones débiles, independientemente del valor de corte analizado de PCR. Por el contrario, se observó una correlación positiva moderada entre los valores positivos intermedios de PCR y HDL (r= 0.53; p= 0.01). Las correlación entre VSG y CT (r=- 0.03; p= 0.58), así como su fracción LDL (r= 0.10; p= 0.88), fueron débiles. Se observó una correlación negativa débil, pero estadísticamente significativa entre VSG y la fracción HDL (r=-0.14; p= 0.02). En el análisis multivariado de regresión lineal la VSG mantuvo una asociación negativa y significativa con los valores de colesterol HDL (coeficiente ß= -0.179, IC95% -0.28 -0.07; p= 0.001). CONCLUSION: En este estudio pudimos corroborar una relación inversa, aunque débil, entre la VSG y la fracción HDLcolesterol, por el contrario, no pudimos reproducir los hallazgos previamente publicados sobre la relación inversa entre la PCR y los niveles séricos de colesterol y sus fracciones. (AU)

INTRODUCTION: Cardiovascular disease (CVD) is the main cause of premature mortality in patients with rheumatoid arthritis (RA). The risk of CVD mortality is increased by approximately 50% compared to the general population. In patients with RA, the cumulative inflammatory burden, as measured by the levels of the globular sedimentation rate (GSR) and the Creactive protein (CRP), has been associated with sub-clinical atherosclerosis, CV risk and mortality. On the contrary, the presence of a proinflammatory state, as observed in patients with RA, may lead to a decline of the total cholesterol (TC) and HDL fraction. This observation suggests that inflammation may play a confounding role in the association of lipids with CVD. OBJETIVO: To correlate acute phase reactants (GSR and CRP) with the lipid measurements (TC, HDL and LDL) in a sample of patients with RA. PATIENTS Y METHOD: In this observational, retrospective and analytic study, we included 318 patients fulfilling the CR/EULAR 2010 criteria for RA. The relationship between the TC, HDL, LDL and the CRP (normal logarithm) and GSR was analyzed with the Pearson´s correlation. In a second model, the relationship of the TC, HDL and LDL with the normal logarithm of CRP was analyzed using different cutoff values (CRP ≤5 mg/l, > 5 a <10 mg/l y >10 mg/l). Finally, all the significant correlations were included in a multivariate linear regression model adjusting for age, gender, disease duration, use of lipid lowering drugs, biologic disease modifying antirheumatic drugs and glucocorticoid doses. RESULTS: The study included 449 measurements of the lipid profile and acute phase reactants. Patients were predominantly women (79.5%) with mean (SD) age of 57.7 (12.3) years. Median (IQR) disease duration was 74.0 (108.0) months. Most of the patients (67%) were either positive for the rheumatoid factor and/or anti-citrullinated antibodies. The correlation of the CRP and TC (r= 0.16; p= 0.6) and their fractions HDL (0.09; p= 0.30) and LDL (r= 0.09; p= 0.36) were positive and weak. In the sub-analyses using the three cut-off values of the CRP, the correlations of both, TC (r= -0.18 to 0.09) and LDL (r= -0.34 to 0.11) were also weak. On the contrary, the correlation between the intermediate values of CRP and HDL was positive and moderate (r= 0.53; p= 0.01). The correlation of the GSR and TC (r=-0.03; p= 0.58) and LDL (r= 0.10; p= 0.88) were weak. There was, however, a negative and significant, although weak correlation between the GSR and HDL (r=-0.14; p= 0.02). In the multivariate analyses, the GSR had a negative and significant association with the levels of HDL (ß coefficient = -0.179, 95%CI - 0.28 -0.07; p= 0.001). CONCLUSION: In this study we confirmed an inverse, although weak, relationship between the GSR and HDL-cholesterol. On the contrary, we were not able to reproduce previous published data regarding the inverse relationship between the CRP values and the levels of the TC or their fractions. (AU)

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Objectives The objectives of this study were to examine the demographic and clinical features associated with the occurrence of pleuropulmonary manifestations, the predictive factors of their occurrence and their impact on mortality in systemic lupus erythematosus (SLE) patients. Materials and methods The association of pleuropulmonary manifestations with demographic and clinical features, the predictive factors of their occurrence and their impact on mortality were examined in GLADEL patients by appropriate univariable and multivariable analyses. Results At least one pleuropulmonary manifestation occurred in 421 of the 1480 SLE patients (28.4%), pleurisy being the most frequent (24.0%). Age at SLE onset ≥30 years (OR 1.42; 95% CI 1.10-1.83), the presence of lower respiratory tract infection (OR 3.19; 95% CI 2.05-4.96), non-ischemic heart disease (OR 3.17; 95% CI 2.41-4.18), ischemic heart disease (OR 3.39; 95% CI 2.08-5.54), systemic (OR 2.00; 95% CI 1.37-2.91), ocular (OR 1.58; 95% CI 1.16-2.14) and renal manifestations (OR 1.44; 95% CI 1.09-1.83) were associated with pleuropulmonary manifestations, whereas cutaneous manifestations were negatively associated (OR 0.47; 95% CI 0.29-0.76). Non-ischemic heart disease (HR 2.24; 95% CI 1.63-3.09), SDI scores ≥1 (OR 1.54; 95% CI 1.10-2.17) and anti-La antibody positivity (OR 2.51; 95% CI 1.39-4.57) independently predicted their subsequent occurrence. Cutaneous manifestations were protective of the subsequent occurrence of pleuropulmonary manifestations (HR 0.62; 95% CI 0.43-0.90). Pleuropulmonary manifestations independently contributed a decreased survival (HR: 2.79 95% CI 1.80-4.31). Conclusion Pleuropulmonary manifestations are frequent in SLE, particularly pleuritis. Older age, respiratory tract infection, cardiac, systemic and renal involvement were associated with them, whereas cutaneous manifestations were negatively associated. Cardiac compromise, SDI scores ≥1 and anti-La positivity at disease onset were predictive of their subsequent occurrence, whereas cutaneous manifestations were protective. They independently contributed to a decreased survival in these patients.

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Introducción: BIOBADASAR (Registro Argentino de Eventos Adversos con Tratamientos Biológicos en Reumatología) comenzó en agosto de 2010. La importancia de este registro es mostrar datos locales que, probablemente, puedan diferir de otros registros. El objetivo es comunicar los resultados del tercer reporte de BIOBADASAR. Métodos: Todos los pacientes con enfermedades reumáticas que requirieron tratamiento con agentes biológicos y pacientes controles sin estos tratamientos fueron incluidos en la base de datos provenientes de 32 centros participando a lo largo de la Argentina. Tres áreas de datos son analizados: características de los pacientes, tratamientos y eventos adversos...

Introduction: BIOBADASAR (Argentine Registry of Adverse Events with Biological Treatments in Rheumatology) began in August 2010. The importance of this registry is to show local data that may probably differ from other registries. The objective is to communicate the results of the third BIOBADASAR report. Methods: All patients with rheumatic diseases who required treatment with biological agents and control patients without these treatments were included in the database from 32 participating centers throughout Argentina. Three areas of data are analyzed: patient characteristics, treatments and adverse events...

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INTRODUCTION: Patients with SLE (Systemic Lupus Erythematosus) are prompt to develop infections with significant morbidity and mortality. The intravascular infection due to salmonella is a rare complication of difficult diagnosis and poor prognostic. OBJECTIVE: We report two cases of bacterial endocarditis due to salmonella in SLE patients. CLINICAL CASES: We report two cases of bacterial endocarditis caused by Salmonella in a patient with SLE, one with recent onset of mellitus diabetes and other with chronic renal failure. Despite of antibiotic treatment with fluoroquinolone and a third-generation cephalosporin, the patient required surgical intervention. CONCLUSION: Salmonella infection should be suspected in SLE patients in order to make earlier diagnosis and treatment.

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Pulmonary complications of primary antiphospholipid syndrome are common and diverse, with thromboembolic events counting as the most frequent manifestation. We present the case of a female patient with a diagnosis of primary antiphospholipid syndrome, pulmonary thromboembolism and infarction followed by lung cavitation.

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OBJECTIVE: To compare the incidence of selected spontaneously reported adverse events (AEs) in patients with osteoarthritis (OA) treated with rofecoxib (VIOXX, 12.5 mg qd) or Arthrotec (diclofenac 50 mg/misoprostol 200 mcg bid). METHODS: Double-blind, parallel-group, 6-week study of patients aged > or = 40 years with a clinical diagnosis of OA treated with rofecoxib or Arthrotec. Primary endpoint: self-reported diarrhea; secondary endpoints: abdominal pain, discontinuations due to AEs, GI AEs and NSAID-type GI AEs (ie., acid reflux, dyspepsia, epigastric discomfort, heartburn, nausea, vomiting). RESULTS: Among 483 patients (80.3% females, mean age 62.1), the rofecoxib group vs the Arthrotec group respectively reported diarrhea 6.2% vs 16.2% (p<0.001); drug-related diarrhea 3.7% vs 16.2% (p<0.001); one or more clinical AEs 52.9% vs 73.0% (p<0.001); GI AEs 28.9% vs 48.5% (p<0.001); NSAID-type GI AEs 18.6% vs 29.9% (p=0.004); discontinuations due to abdominal pain 0.4% vs 3.7% (p<0.05); and discontinuations due to any AE 4.1% vs 9.1% (p=0.029). No significant differences were observed in efficacy. CONCLUSION: Rofecoxib 12.5 mg qd has improved GI tolerability and similar efficacy compared to Arthrotec (diclofenac 50 mg/misoprostol 200 mcg bid).

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